[Congressional Record (Bound Edition), Volume 150 (2004), Part 15]
[Senate]
[Pages 20318-20321]
[From the U.S. Government Publishing Office, www.gpo.gov]




                WELFARE REFORM EXTENSION ACT, PART VIII

  Mr. FRIST. Mr. President, I ask unanimous consent that the Senate now 
proceed to consideration of H.R. 5149, which is at the desk.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (H.R. 5149) to reauthorize the Temporary Assistance 
     for Needy Families block grant program through March 31, 
     2005, and for other purposes.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. GRASSLEY. Mr. President, the state of children's health insurance 
program, or SCHIP, is one of the largest and most successful expansion 
of public health insurance for children since the creation of Medicaid. 
This vitally important program was created through a bipartisan 
commitment to expanding health coverage for children. Because today is 
the last day of the fiscal year for the Federal Government, $1.1 
billion in unspent SCHIP funds are set to expire. These are funds that 
have been reallocated and then subsequently have had their availability 
extended several times over the past few years. In addition 
approximately $660 million in unspent 2002 state allotments are 
available to Secretary Thompson to redistribute to states that have 
spent their 2002 allotments.
  I want to go on the record to say that I am absolutely committed to 
finding a bipartisan solution that will keep the $1.1 billion in the 
SCHIP program. Congress can, and should, address this issue before 
recessing in October, but if not, certainly before the close of the 
session. I want to work together with my colleagues in both parties 
toward a productive approach. The SCHIP program was created when people 
reached across the aisle and joined together to do the right thing to 
get kids health coverage. Today we need to move forward with this same 
spirit of cooperation and commitment.
  We can also improve the SCHIP program to get more kids covered. In 
2003, SCHIP covered 5.8 million targeted low-income individuals. 
However, a substantial number of children who are eligible for health 
coverage through SCHIP are not enrolled. This is a serious issue that 
deserves our thoughtful attention. We can do better.
  The Federal Government should commit itself to getting more of these 
kids enrolled. They are entitled to health coverage under this vitally 
important program, yet billions of SCHIP dollars lie unspent. These 
unspent dollars are not helping any children today. I would

[[Page 20319]]

hope that we can work out a plan to target a portion of the $1.1 
billion in expiring SCHIP funding towards a coordinated SCHIP outreach 
plan so that as many eligible children as possible receive the coverage 
they deserve.
  Of course, I am aware that there are fiscal concerns from states that 
can impede their ability to use State dollars to match Federal SCHIP 
dollars. Some are also concerned that increased enrollment will place a 
burden on states already struggling with the rising cost of health 
care. I really believe, however, that we can find a way to get more 
kids covered and provide states incentives to do so.
  The fact that these funds are expiring does not mean that the SCHIP 
program is in danger of imminent collapse. That is not the case. While 
I am informed by CMS that six States face potential SCHIP shortfalls in 
FY05, Secretary Thompson has indicated that, unless Congress passes 
legislation to address these shortfalls, he will redistribute the 
approximately $660 million in 2002 allotments, which is more than 
enough to make up for these shortfalls in 2005.
  Working together, Congress can reallocate the expiring $1.1 billion 
after tomorrow with no impact on the SCHIP program. In fact, in the 
past, Congress has acted months later to reallocate expired SCHIP funds 
back into the program. So it is not the case that September 30th is the 
``drop dead date'' for action. In fact, when the FY1998 and FY1999 
reallocations expired at the close of FY2002, Congress acted in 2003 to 
``reinstate'' these funds through September 30, 2004. So, even if 
Congress acts in November to reallocate these funds, this is how 
Congress has dealt with the issue in the past and it can be done again.
  We can work together to get the job done. I am committed to working 
with members on both sides of the aisle to reach a bipartisan agreement 
so that we can keep the $1.1 billion in the SCHIP program, address the 
projected 6-state shortfall and get as many kids as possible the health 
care coverage for which they are entitled. I believe we can do it if we 
all commit ourselves to putting kids first and moving ahead together.
  Mr. HATCH. Mr. President, as one of the original authors of the CHIP 
program, I rise to share my strong support for the Children's Health 
Insurance Program, CHIP. Many are very worried about unspent CHIP 
dollars for fiscal year 2002 going back to the Treasury after today. I 
share those concerns. I want that $1.1 billion to remain available so 
it can be used to pay for health coverage for children. So does the 
President. So do my colleagues in both the Senate and the House of 
Representatives. There is no disagreement on that issue. Let me assure 
you that this will be resolved.
  Regardless of what happens on October 1, every State will receive its 
new CHIP money for fiscal year 2005. Simply put, all States will be 
given the funds to cover their CHIP expenses while Congress continues 
to work on ways to use the unspent CHIP money from fiscal year 2002. It 
is important to remember that Congress has the power to restore these 
unspent CHIP funds to states once the new fiscal year has begun. In 
fact, just last year, Congress acted to restore unspent CHIP funds from 
fiscal years 1998 and 1999 to states several months after these funds 
went back to the Treasury. And, let me emphasize, once again, the 
fiscal year 2002 CHIP funds are not needed by any State for its 2005 
CHIP program. No child is in danger of losing his or her CHIP coverage.
  CHIP has been, for the most part, a great success. Today, there are 
5.8 million children enrolled in the CHIP program. We have made good 
progress in providing health insurance to uninsured children. We have 
had great successes with the CHIP program since 1997, when it was first 
created.
  However, important issues concerning the program still must be 
addressed. I believe that the No. 1 issue is reaching out to CHIP-
eligible children who currently are not covered by the program. While 
many States have been successful with their outreach efforts, that is 
not the case in all States. I am particularly troubled by the 
difficulties faced by Native American children. Outreach must be 
addressed by Congress--my primary goal when we were drafting the 
original CHIP legislation in 1997 was to ensure that CHIP was available 
for all eligible children.
  My biggest concern with one approach for spending the unspent fiscal 
year 2002 funds is contained in S. 2759, authored by Senators 
Rockefeller, Chafee, Kennedy and Snowe, is that it does not directly 
help enroll the millions of uninsured children who are eligible for 
CHIP program. I have reviewed the Rockefeller-Kennedy bill and I am not 
convinced that it does anything to increase CHIP enrollment. Providing 
health insurance coverage under CHIP to uninsured children should be 
our top priority, not redistributing CHIP funding to states. Congress 
has redistributed leftover CHIP funds to states more than once and I am 
sure that the legislation has made a significant difference in 
increasing CHIP enrollment of uninsured, CHIP-eligible children.
  That is why I am advocating a different approach and placing a higher 
priority on outreach to these uninsured children. I strongly support 
the President's goal to have a broad outreach effort through community-
based entities such as hospitals, schools, Indian Health Service 
hospitals and clinics, tribes and tribal organizations, non-profit 
community organizations, and Federally-qualified health centers. I also 
support performance-based grants for states that are successful in 
enrolling and covering children. These states should be rewarded for 
their successes in covering more children, instead of facing higher 
state costs.
  While today marks the end of the fiscal year, it does not mark the 
end of the CHIP program. It does not mean that the CHIP program is 
going to lose money. It does not mean that states are going to run out 
of CHIP funds tomorrow. We all agree that these funds should remain in 
the CHIP program--we just have different ideas on how that money should 
be spent. Regardless, I am convinced that we will be able to work 
together on a solution regarding this important issue. I urge all of my 
colleagues to work to ensure that all eligible children are covered 
under the Children's Health Insurance Program.
  Mr. BINGAMAN. Mr. President, I come to the floor today to express my 
dismay that the administration and the Congress have failed to prevent 
almost $1.1 billion in money that has been previous allocated to the 
State Children's Health Insurance Program, or SCHIP, from expiring. 
Families USA points out that the loss of these funds approximate the 
annual cost of providing health coverage to almost 750,000 children. 
That failure is unacceptable for a nation such as ours.
  However, I am pleased to report that both Finance Committee Chairman 
Grassley and Senator Baucus are moving quickly to pull together a 
bipartisan group together to resolve this problem as soon as possible. 
Considering that the chairman is the author of important pieces of 
legislation, such as the Family Opportunity Act, to improve the health 
of our Nation's children with special health care needs, it should come 
as no surprise that he is working to bridge the gap between legislation 
introduced by Senators Rockefeller and Chafee that would preserve and 
reallocate the $1.1 billion in SCHIP funds and the administration's 
stated position to preserve the funding but take those dollars 
currently dedicated to health insurance coverage and use them instead 
``to enroll more children who remain uninsured despite being eligible 
for coverage.''
  In light of the chairman's dedication to the issue and commitment to 
a bipartisan solution, I am hopeful that we will get this resolved, and 
I urge all parties to work toward a compromise as soon as possible.
  What is at stake here? According to data from a Kaiser Commission on 
Medicaid and the Uninsured report that was released on Monday, there 
were over 9.1 million children who were uninsured in our country in 
2003. There have been important strides made in reducing the number of 
uninsured children since the passage of SCHIP, as the

[[Page 20320]]

number of uninsured has dropped from 9.4 million uninsured in 2000 to 
the 9.1 million in 2003. The uninsured rate would have increased 
dramatically if not for SCHIP. In fact, the uninsured rate for adults 
during this same time-period increased from 30.2 million to 35.5 
million.
  Regardless of the improvement in children's health, the fact that 
over 9 million children remain uninsured is absolutely unacceptable for 
a nation such as ours.
  In fact, if every single child living in the 21 States of Alaska, 
Arkansas, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Mississippi, 
Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, 
Rhode Island, South Dakota, Utah, Vermont, West Virginia, Wyoming, and 
the District of Columbia were uninsured, that would still be less than 
9 million children. In other words, the number of children without 
health insurance in our nation exceeds the number of all children 
living in 21 states and the District of Columbia combined.
  That is not something anybody in the administration or this chamber 
should find acceptable. We should be doing everything in our power to, 
at the very least, preclude the loss of over $1 billion that could be 
used to reduce that uninsured rate.
  In New Mexico, the loss of this money is coupled with the loss of an 
expiring provision that is very important to our State and 10 others. 
The Center on Budget and Policy Priorities estimates that New Mexico 
will lose at least $20 million over the next few years in money for 
children's health if the administration and Congress fails to act.
  Moreover, there was a very important provision that was included in 
the last redistribution effort that allows the 11 States, including New 
Mexico, Connecticut, Hawaii, Maryland, Minnesota, New Hampshire, Rhode 
Island, Tennessee, Vermont, Washington, and Wisconsin, to use up to 20 
percent of allotted and retained funds by our States on children who 
are enrolled in Medicaid with income above 150 percent of poverty. This 
provision was included to recognize that our 11 States had enacted 
health care expansions for children prior to the enactment of SCHIP and 
were being effectively penalized financially for having done the right 
thing for children prior to 1997. The reason is that children in the 
other 39 States are able to receive an enhanced matching rate for 
children as low as 100 percent of poverty while children in states such 
as Washington cannot receive an enhanced matching rate until a child 
lives in a family with income above 200 percent of poverty.
  This important compromise, which significantly reduces the inequity 
among the States, was achieved in large part due to the hard and 
dedicated work of Senators Murray, Cantwell, Jeffords, Leahy, Chafee, 
Reed of Rhode Island, Domenici, and Frist.
  Unfortunately, that critically important provision will also 
effectively expire tonight. This will have a detrimental impact on the 
health and well-being of the children in these States, as this has been 
funding that our states have counted on for the delivery of children's 
health services in both Medicaid and SCHIP for fiscal year 2005.
  In Secretary Thompson's letter to Senator Grassley on Tuesday and the 
majority Leader's letter to Senator Chafee on September 24, 2004, they 
both failed to recognize this issue. It is for that reason I raise it 
here again in the Senate to remind my colleagues and the administration 
that it is an important issue to our 11 States, including that of the 
Majority Leader, and that, just as we must find a solution to restoring 
the $1.1 billion in expiring funding for SCHIP, we must also get this 
other issue resolved as soon as possible.
  I strongly urge the administration to reconsider its position that 
the $1.1 billion should be completely diverted from health coverage to 
outreach and enrollment. If implemented as proposed, it would result in 
over 20 percent of SCHIP dollars in 2005 going to outreach and 
enrollment. While I am a strong supporter of outreach and enrollment in 
SCHIP, this proposal is both extreme and excessive. In fact, it should 
be noted that beginning in fiscal year 2002 that expenditures of 
federal SCHIP funds have begun to exceed federal SCHIP allotments. 
Therefore, keeping as much funding in actual health coverage is 
critically important to continue to reduce the number of uninsured 
children in our nation.
  On the other hand, as the sponsor of legislation with the 
Congressional Hispanic Caucus that authorizes the use of $50 million of 
SCHIP funding for outreach and enrollment that was subsequently picked 
up by the majority leader in legislation he introduced, I firmly 
believe setting aside a limited portion of the $1.1 billion for 
outreach and enrollment is both necessary to reach a compromise and 
would also result in better health coverage for children.
  In fact, of the 9.1 million uninsured, according to data from the 
Kaiser Commission on Medicaid and the Uninsured, 6.8 million live in 
households that have incomes below 200 percent of poverty, which is the 
level at which most States provide a combination of coverage for 
children through either their Medicaid or State Children's Health 
Insurance Programs. While some of these children would not be eligible 
for either Medicaid or SCHIP due to their immigration status, it is 
clear from a variety of studies that somewhere between 60 to 85 percent 
of uninsured children are eligible for but not enrolled in either 
Medicaid or SCHIP.
  Princeton University's publication entitled The Future of Children 
dedicated much of one issue to looking at successful efforts to improve 
outreach and enrollment. As one of its articles notes, ``Most important 
to reducing the uninsurance problem facing children is raising 
participation in Medicaid and SCHIP, as 76 percent of uninsured 
children are already eligible for coverage under SCHIP and Medicaid, 
but are not enrolled. A continued focus on simple and convenient 
enrollment and renewal systems, as well as proactive outreach and 
educational efforts, will be key to reaching these children. Special 
efforts will be needed to enroll Latino and other minority children, 
children in immigrant families (families in which at least one member 
is an immigrant), and adolescents. Children in these groups are all 
over-represented in the ranks of the eligible, but uninsured.''
  In New Mexico, we have our own special program along the U.S.-Mexico 
border that has been funded by the Bureau of Primary Health Care called 
Border VISION Fornteriza. The program funds the recruitment and 
training of community health workers or promotoras that have over the 
years successfully assisted in the enrollment of thousands of children 
into health coverage through Medicaid and SCHIP. The program was 
honored as a model program by the U.S.-Mexico Border Commission and it 
is precisely this type of program that should be encouraged in whatever 
agreement is reached.
  As a point of comparison, when Congress passed the Medicare 
prescription drug bill last year, hundreds of millions of dollars was 
dedicated to doing outreach and enrollment to senior citizens and 
people with disabilities about the prescription drug cards and the 
pending drug coverage. In contrast, while States can spend some of 
their administrative dollars in SCHIP on outreach and enrollment, there 
are no federal funds exclusively dedicated to conduct outreach and 
enrollment efforts in either Medicaid or SCHIP.
  That should change, and I hope my colleagues will closely review the 
language introduced by me as part of S. 1159 and in S. 2091 introduced 
by the majority leader on providing outreach and enrollment funding for 
children's health.
  And finally, I am also hopeful that the Senate will consider 
legislation by Senator Lugar and me that would streamline enrollment of 
children in either Medicaid or SCHIP. Just as we know that low-income 
senior citizens and the disabled enrolled in Medicare Savings Programs 
are clearly income eligible for the new Medicare prescription drug card 
and its $600 annual subsidy, I had introduced legislation with Senator 
Lincoln to auto-enroll those Medicare beneficiaries into the drug card 
to get the $600 subsidy.

[[Page 20321]]

  Dr. Mark McClellan, Administrator of the Centers for Medicare and 
Medicaid Services, or CMS, worked hard and has agreed that those 
beneficiaries should be presumed income-eligible and sent the card for 
them to activate. Over 1 million low-income senior citizens and people 
with disabilities will now be getting access to the drug card subsidy 
that would not have otherwise received those funds.
  The same type of mechanism should be applied to children' health. The 
Children's Partnership and the Kaiser Family Foundation recently 
released a report on what they call ``Express Lane Eligibility.'' This 
concept is encompassed in Senator Lugar's legislation by employing 
``two common-sense strategies to find and enroll these nearly seven 
million `eligible but uninsured' children in health insurance coverage. 
. . .''
  Those common-sense strategies are: No. 1, it targets large numbers of 
eligible children where they can be found: in other public benefit 
programs like school lunch and food stamps. More than 70 percent of 
low-income uninsured children are already receiving other public 
assistance benefits of some kind; and No. 2 it expedites children's 
enrollment in health coverage by using information already submitted by 
parents when they enrolled their children in other benefit programs.
  Again, I urge the Congress to also closely look at this successful 
model to improve enrollment of children into health insurance coverage.
  I am terribly disappointed that the expiring SCHIP funds were not 
retained in a timely manner, but am hopeful that under the leadership 
of both Senators Grassley and Baucus that we will quickly come to a 
resolution of this issue in which all the $1.1 billion in restored and 
retained for children's health. Furthermore, I am hopeful that a 
portion of that funding will be allocated to outreach and enrollment of 
children and for streamlining enrollment mechanisms into the program.
  Mr. SMITH. Mr. President, as we approach the end of the fiscal year, 
there are many important issues that require our attention. Not the 
least among them is the extension of $1.1 billion in unspent S-CHIP 
funding that will revert to the Treasury if Congress does not take 
action. This is a vitally important program to the State of Oregon, and 
to America's children. We must take action to protect this funding.
  The State Children's Health Insurance Program, created in 1997, has 
always had bi-partisan support. Shortly after being elected to the 
United States Senate in 1996, I strongly supported the creation of this 
program. I knew that Congress had an opportunity to reach out to 
millions of low-income children and provide health care coverage. 
Working with my colleagues and friends, including Senators Orrin Hatch 
and Edward Kennedy, in the development of the bipartisan proposal was a 
pleasure.
  Since 1997, we have all continued to work together, members from both 
sides of the aisle, to extend funding and make improvements to the 
program. This year should be no different. I know it is an election 
year, a presidential election year in fact, and that often creates a 
dynamic where politics can overwhelm policy. However, I am hopeful that 
we can once again triumph over partisanship and pass legislation that 
will intervene and prevent the expiration of $1.1 billion in unspent S-
CHIP funding. I am confident that if both sides are reasonable and 
willing to work together we can accomplish this goal by the time 
Congress recesses on October 8.
  As we prepare to take action on a bill, we need to consider that no 
one member or group of members have all of the answers; that nobody has 
a monopoly on protecting America's children. We all work every day to 
protect our Nation's children and ensure that those who come from low-
income families receive the nutritional, housing, education and health 
care assistance that they need. This time should be no different.
  I look forward to working with Senators Hatch and Kennedy, the 
creators of this remarkable program; President Bush, a strong advocate 
for our nation's children; Leader Frist, Chairman Grassley and others 
to extend funding for this important program.
  Mr. FRIST. I ask unanimous consent that the bill be read a third time 
and passed, the motion to reconsider be laid upon the table, and any 
statements relating to the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill (H.R. 5149) was read the third time and passed.

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